Table 5:

E1–E3 nursing performance during simulation

Table E1: nursing completion of key practice guidelines for impella patient during simulation sessions (n=9)
Task	Complete	Incomplete
Two-dimensional (2D) echo verification of placement
Simulation #1	11% (1)	89% (8)
Simulation #2	100% (9)	0% (0)
CM marking verified
Simulation #1	44% (4)	55% (5)
Simulation #2	100% (9)	0% (0)
Tightening of Toughy Borst valve
Simulation #1	0% (0)	100% (9)
Simulation #2	78% (7)	22% (2)
Transfer to standard configuration
Simulation #1	89% (8)	11% (1)
Simulation #2	89% (8)	11% (1)
Purge solution verified and hung
Simulation #1	0% (0)	100% (9)
Simulation #2	78% (7)	22% (2)

Table E2: average time to complete critical tasks for Impella patient during simulation (n=9)
Activity	Simulation 1	Simulation 2
2D echo verification	5 min 32 s	1 min 32 s
CM marking	5 min 13 s	3 min 55 s
Standard configuration	4 min 3 s	4 min 20 s
Purge solution verified	No groups fully completed*	2 min 18 s
Purge solution hung	No groups fully completed*	3 min 13 s

Table E3: nursing recognition and management of alarms for impella patient during simulation sessions (n=9)
	Recognised alarm (suction, aorta/ventricle)	Correctly identified cause of alarm	Correct identification of action(s) to resolve alarm	Notified physician with recommendation	Notified physician without recommendation
Simulation #1	100% (9)	33% (3) (suction alarms only)	33% (3) (suction alarms only)	33% (3) (suction alarms only)	67% (6)
Simulation #2	100% (9)	100% (9)	100% (9)	100% (9)	0% (0)

*During simulation #1, all groups partially completed the task of verifying the purge solution change to dextrose plus heparin by simply hanging the solution. However, none of groups changed the information in the Impella console; therefore, the console remained programmed as having only dextrose infusing as the purge solution and would not recognise or calculate the amount of heparin in use and delivered to the patient.